Infertility is a part of life for 1 in every 8 couples in the United States. Most people know that risk factors like age and tobacco use can make having a baby difficult, yet, there are young, tobacco-free families who struggle to get pregnant in every community. Because knowledge is critical in safeguarding your reproductive health, here are five causes of infertility you may never have heard of.
1. LEEP Procedures
If you’ve ever had an abnormal Pap smear, you may have heard of LEEP (Loop Electrosurgical Excision Procedure). With this treatment, doctors use an electrically heated wire loop to cut abnormal cells off the cervix. This works very well to protect a woman from cervical cancer. If she gets pregnant afterward, however, it also increases her risk of a devastating second-trimester miscarriage or premature birth.
There are other methods to treat suspicious cells, like cryotherapy, which may have fewer fertility risks. But depending on how abnormal your tests are, those treatments may not make you and your doctor feel confident enough that you’ve stopped cancer in its tracks. If you’re ever in this position, make sure your provider knows about your plans for your fertility so she can balance all the goals of treatment.
2. Abortion
It’s a common myth that terminating a pregnancy can’t cause infertility. Planned Parenthood’s website confidently reassures patients that having an uncomplicated abortion “[doesn’t] affect your fertility.” But a small percentage of abortions will have complications, and some of those complications are associated with subsequent infertility. The two complications most associated with future infertility are Asherman Syndrome and post-abortion infections.
Asherman Syndrome
Any single surgery on the womb (including procedures to end a pregnancy) can lead to a condition called Asherman Syndrome. With Asherman, bands of scar tissue form inside the uterus that can sometimes make conception difficult—or impossible. Worst of all, surgeries to try to correct the problem can cause more damage, sending women and their bodies into a frustrating and heartbreaking cycle of treatment and scarring. A 2021 study of 2,546 women who’d had surgical abortions before 20 weeks gestation found that 1.6% of women developed Asherman Syndrome, though women who had had 3 or more abortions had significantly higher rates.
Post-abortion infections
The Society for Family Planning, which itself supports abortion access, notes that postabortal infection risk is around 1% in general, but acknowledges that risk is significantly higher for women with untreated sexually transmitted infections (STIs) such as Chlamydia and/or Gonorrhea at the time of their abortions.
Importantly, SFP’s Clinical Guidelines for Prevention of infection after induced abortion report that women who present for induced abortions may have 4.5-10xhigher rates of untreated STIs than women in the general population. For example, “In a national sample of females in the United States aged 14–39, the prevalence of Chlamydia trachomatis infection was 2.5% and Neisseria gonorrhoeae was 0.3% [65].” In contrast, “A recent cross-sectional study in the US of women seeking first-trimester abortion in the US found 11% to have a positive Chlamydia test and 3% a positive gonorrhea test [66].”
Postabortal infections can cause pelvic inflammatory disease, meaning “an infection and inflammation in any of the reproductive organs,” according to the University of California-San Diego. According to the American College of Obstetricians and Gynecologists, “One in 10 women with PID becomes infertile.”
3. Aspirin (and other NSAIDs)
Non-steroidal anti-inflammatory drugs: You probably know them best by their over-the-counter brand names like Motrin, Advil, or Bayer Aspirin. Researchers have repeatedly found that these medicines, taken regularly, can be astonishingly effective at reducing ovulation rates. In one small 2015 study, naproxen (often sold in the United States under brand name Aleve) lowered ovulation rates by 75%. Ibuprofen has been shown to have a similar fertility-reducing effect in men. In both sexes, NSAID drugs in high doses appear to disrupt important reproductive hormones.
The good news for couples trying to both manage pain and conceive is that these side effects are temporary and reversible, once patients stop taking the medication.
4. Hyperprolactinemia
As the “lact” in the name suggests, prolactin is a hormone that plays a role in milk production and breast development. Women couldn’t breastfeed without it! In hyperprolactinemia, the pituitary gland secretes too much prolactin, often causing milk leakage, vision problems, irregular periods and infertility. Some patients have no symptoms at all, and it’s estimated about 10% of the population, both men and women, would have high prolactin levels if they were tested in a lab. This condition can have a number of causes—from antidepressant pills to thyroid imbalances to a tiny, benign tumor in the pituitary gland called a prolactinoma.
5. Low Progesterone
Progesterone is a key hormone in the process of getting and staying pregnant. A drop in progesterone is what triggers a period in a woman’s cycle, so it stands to reason that a woman needs sufficiently elevated levels to keep her uterus a stable, safe environment for a tiny embryo. But for some women, their bodies do not produce enough progesterone in the second half, or luteal phase, of their cycle after ovulation. For decades, this luteal phase deficiency has been associated with miscarriages and infertility. Progesterone deficiency is also common birth-control side effect, and it can take a number of cycles for a woman’s hormones to rebalance after getting off hormonal birth control.
Luckily, low progesterone can be treated with hormonal supplements, which are proven safe and effective in pregnancy. A simple, inexpensive pill or cream can help couples bring home a baby. By practicing Natural Family Planning or Fertility Awareness-Based Methods, women can detect symptoms of low progesterone before conceiving—making treatment proactive.
If you are trying to conceive and suffering from infertility, you are not alone. Many couples who learn a Fertility Awareness-Based Method or Natural Family Planning can read their body’s signs in their monthly cycle, identify root problems behind their infertility, seek treatment, and cut in half their time of trying to conceive naturally. Whether or not one is able to conceive, learning more about what’s going on in our bodies is empowering information that helps remove some of the mystery and shame surrounding infertility, and for many couples, that is an essential step toward peace.
This article was last updated on April 25th, 2023 to include additional information about Asherman Syndrome and infection risks after abortion.
Reference
National Infertility Association: Fast Facts on Infertility
How Lack of Fertility Awareness Relates To Infertility Rates
